Current Trends and Issues in Managed Care Using the South University Online libr

Question

Current Trends and Issues in Managed Care Using the South University Online library or the Internet, research on a series of topics that will help you understand the current issues regarding managed care. You can use keywords, such as (but not limited to) managed care, current trends and issues in managed care, pharmacy benefit management, or utilization management. Like many other aspects of health care, managed care is continually changing and evolving to meet current consumer and market demands. This week, you are required to write an essay on the following topics:

•Pharmacy benefit management

•Utilization management Present a summary for each topic tying together the information learned about that topic.

•Describe and evaluate the market forces, current trends, and changes in drug benefit programs over the last fifteen years.

Explanation / Answer

Esay on the Topic:

Pharmacy Benefit Management

Pharmacy Benefit management is the management of the administration of prescription drugs, done by a third party known as a Pharmacy Benefit Manager or PBM. PBMs have the responsibility to develop the list of prescription drugs needed (their formulas or compounds, also known as formulary), contract with pharmacies and drug manufacturers, negotiate drug prices and discounts, to reduce or manage the cumulative pharmacy expenses of the prescription drug plans for government programs, self insured organizations, etc.

Since PBMs are third party responsible for price negotiations; hence they aggregate the requirements of their clients, be it the self insured companies, or the government programs or even individuals, which helps them achieve much lower prices form the pharmacies or the drug manufacturers than the clients can obtain from individual negotiations.

PBMs also provide its clients with valuable information that helps them achieve lower costs of prescription drugs, like better and more reasonable therapeutic alternatives, pharmacies providing mail order services, clinical programs, etc.

To obtain a position of PBM, individuals need solid knowledge of the pharmacy subject; hence degrees pr certifications in pharmacy are needed. Also, knowledge and interest in economic principles governing pharmacy and business practices is needed.

Some of the major PBM organizations functioning in the country are Express Scripts, CVS health and United Health Group.

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